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Nonunion in surgically repaired tibial fractures predictable at 3 months


Patients with a tibial fracture that requires surgical repair with intramedullary nails normally wait 6 months for a second operation if their fracture fails to heal. In this study, Yang et al. investigated the accuracy with which trained trauma surgeons could predict nonunion of tibial fractures at 3 months after initial surgery with nails.

The 3-month radiographs and the clinical history of each of 56 consecutive patients that fitted this profile were given to three trauma surgeons, along with a questionnaire to elicit their decision and reasoning. The results were collected between 2005 and 2009. When the results were combined, surgeon opinion had a predictive diagnostic accuracy of 74% with a sensitivity of 62% and a specificity of 77%. For patients with this injury who also had diabetes, the overall diagnostic accuracy increased to 88%.

Editor’s comment: Surgeons supplied with clinical data can accurately predict nonunion in patients with tibial fractures treated with intramedullary nails. The authors suggest that looking at the radiographic data and the mechanism of injury can predict nonunion at 3 months and could enable patients to have reoperation sooner, preventing a longer period of disability, lack of independence and pain.

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